A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

Srirangan, Arthihai; Pushpakumara, Jagath; Wanigasuriya, Kamani

doi:10.1186/s12890-020-1070-9

Cited by 6 publications

(7 citation statements)

References 12 publications

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“… 23 Another report by Srirangan et al highlights the development pulmonary hemorrhage in a patient with hump-nosed viper bite and it was managed effectively with systemic steroids. 24 …”

Section: Discussionmentioning

confidence: 99%

Plasmapheresis for Pulmonary Hemorrhage Following Viperine Snakebite: Case Report with Review of Literature

Sampley

Sakhuja

Bhasin

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Introduction Snakebites are one of the commonest occupational hazards in tropical countries and viperine bites are potential to cause systemic toxicity. Coagulopathies and acute kidney injury (AKI) have been documented and easily dealt with in past, but pulmonary hemorrhage has been rarely seen and plasmapheresis has shown promising result for the same. This case reports highlight the effective use of plasmapheresis for pulmonary hemorrhage post-snakebite. Background Viperine snakebite has been associated with high morbidity and mortality due to its toxic systemic envenomization. The important systemic manifestations are coagulopathy, neuromuscular paralysis, AKI, myotoxicity, and cardiovascular collapse. Antivenomization, renal replacement therapy, steroids, and other supportive care are considered to be the mainstay of treatment till date. Pulmonary hemorrhage has been an unusual manifestation of viper bite and rarely reported and steroids have been used in such scenario but with mixed results. Role of plasmapheresis has been documented in the management of snakebite but especially for hematological problems and in limb preservation/salvage strategies. The use of same, for pulmonary hemorrhage has not been studied yet. Here, we present a rare case of pulmonary hemorrhage along with renal failure following viper bite which was successfully treated with plasmapheresis. To the best of our knowledge, it is a rare presentation and has not been reported in the literature reviewed till date. Case description A previously healthy, 36-year-old man presented to our hospital 48 hours after a viper bite. He developed local as well systemic manifestations evident as hemolysis and renal failure. Gradually, he started having hemoptysis followed by respiratory failure requiring ventilatory support. CT chest done was s/o bilateral pulmonary hemorrhages correlating clinically with ongoing tracheal bleed. He had no other bleeding manifestations and had normal coagulation profile. He was initially treated with methylprednisolone therapy, but then did not show any improvement and finally plasmapheresis was done as rescue therapy. Following this, he had improvement in respiratory parameters and settling tracheal bleed with resolution of radiological changes. He was successfully weaned off from the ventilation and also his renal failure also improved with near normalization of pulmonary and renal functions. Conclusion This case highlights the unusual presentation of pulmonary hemorrhage in a patient with viperine bite with normal coagulation and was aggressively managed with plasmapheresis. Hence, plasmapheresis can be used as life-saving modality in patients with systemic envenomization post-viperine bit. How to cite this article Sampley S, Sakhuja V, Bhasin D, Singh K, Singh H. Plasmapheresis for Pulmonary Hemorrhage Following Viperine Snakebite: A Case Report with R...

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“… 23 Another report by Srirangan et al highlights the development pulmonary hemorrhage in a patient with hump-nosed viper bite and it was managed effectively with systemic steroids. 24 …”

Section: Discussionmentioning

confidence: 99%

Plasmapheresis for Pulmonary Hemorrhage Following Viperine Snakebite: Case Report with Review of Literature

Sampley

Sakhuja

Bhasin

et al. 2020

Indian Journal of Critical Care Medicine

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“…Sri Lankan Daboia russelli venom, containing MP and other hemorrhagic toxins, was suspected of causing massive pulmonary hemorrhage in a 30-year-old man six hours after the bite, along with paralysis, renal failure, rhabdomyolysis, and deep vein thrombosis [ 60 ]. Pulmonary hemorrhage was also reported in patients bitten by Hypnale hypnale , accompanied by symptoms of thrombotic microangiopathy (TMA) such as renal failure, coagulopathy, and dry gangrene of both feet [ 61 ]. One fatal case from H. hypnale resulted in severe systemic bleeding, including intracerebral, endocardial, pericardial, and pulmonary hemorrhage and TMA.…”

Section: Impaired Normal Cell Functions and Integritymentioning

confidence: 99%

“… Throm. Snakes Viperids Daboia russelli Phospholipase A 2 (VRV-PL-VIIIa) √ Alveolar cytotoxicity Humans [ 14 , 18 , 33 , 60 ] MMP √ Vascular damage Procoagulant (cerebellar infarction) √ Neurogenic pulmonary edema Nephrotoxins √ Renal failure Hypnale hypnale Unknown hemorrhagic toxins √ Unknown Humans [ 15 , 61 ] Nephrotoxins √ …”

Section: Overall Clinical Presentation and Therapymentioning

confidence: 99%

Pulmonary involvement from animal toxins: the cellular mechanisms

Thumtecho,

Suteparuk,

Sitprija

2023

J. Venom. Anim. Toxins incl. Trop. Dis

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Venomous animals and their venom have always been of human interest because, despite species differences, coevolution has made them capable of targeting key physiological components of our bodies. Respiratory failure from lung injury is one of the serious consequences of envenomation, and the underlying mechanisms are rarely discussed. This review aims to demonstrate how toxins affect the pulmonary system through various biological pathways. Herein, we propose the common underlying cellular mechanisms of toxin-induced lung injury: interference with normal cell function and integrity, disruption of normal vascular function, and provocation of excessive inflammation. Viperid snakebites are the leading cause of envenomation-induced lung injury, followed by other terrestrial venomous animals such as scorpions, spiders, and centipedes. Marine species, particularly jellyfish, can also inflict such injury. Common pulmonary manifestations include pulmonary edema, pulmonary hemorrhage, and exudative infiltration. Severe envenomation can result in acute respiratory distress syndrome. Pulmonary involvement suggests severe envenomation, thus recognizing these mechanisms and manifestations can aid physicians in providing appropriate treatment.

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“…First of all, this is explained by the wide range of effects of the poison on the victim's body, as well as the possibilities of using it for medical purposes and making antidotes. The toxins of snakes from different families vary considerably [27,29,34]. However, it was established that many structural elements are identical for all snakes [36].…”

Section: Introductionmentioning

confidence: 99%

Morphological state of lungs of rats under the influence of Vipera berus berus venom

Lasavutz,

Yaremenko,

Butska

et al. 2024

Rep. of Morph.

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About 5.4 million snake bite cases are registered worldwide every year. About half of them cause 81,000-138,000 deaths or disabled 400,000 people. Despite this, this problem is neglected in many countries in Asia, Africa and Latin America. It is believed that death from snakebites is associated with poverty since the lack of proper access to medical facilities in such sections of the population causes the development of fatal complications. The purpose of the study is to study the morphological state of rats' lungs under exposure to Vipera berus berus venom. Experimental studies were carried out on white, non-linear male rats. Animals were conditionally divided into control and experimental groups, ten individuals each. Experimental rats were injected intraperitoneally with a semi-lethal dose (LD50) (1.576 mg/g-1) of Vipera berus berus venom in a physiological solution. Animals of the control group were injected intraperitoneally with only a physiological solution. Rats were removed from the experiment 24 hours after exposure to the poison and anaesthetized by cervical dislocation. Lung tissue samples were taken for microscopic examination. Fixation of the material and preparation of paraffin blocks were carried out according to generally accepted methods. Staining of histological preparations of the lungs was carried out with hematoxylin and eosin, according to Masson, and the PAS+"Hale" reaction was carried out according to the Mowry method. Histological preparations were studied using an SEO SСAN light microscope. The toxic effect of Vipera berus berus venom caused significant changes in the vascular, stromal and parenchymal components, which was confirmed by histological, histochemical and morphometric data. In the lungs of experimental animals, the vascular bed is primarily restructured, forming coagulopathies and thrombosis. The development of DIC syndrome and haemorrhages accompanies an increase in the permeability of the vessel wall. Inflammatory phenomena are found in the bronchi and respiratory departments' walls. There is a remodelling of the respiratory department components, with the formation of significant areas of dis- and atelectasis and zones of emphysema, which is confirmed morphometrically.

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A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

Cited by 6 publications

References 12 publications

Plasmapheresis for Pulmonary Hemorrhage Following Viperine Snakebite: Case Report with Review of Literature

Plasmapheresis for Pulmonary Hemorrhage Following Viperine Snakebite: Case Report with Review of Literature

Pulmonary involvement from animal toxins: the cellular mechanisms

Morphological state of lungs of rats under the influence of Vipera berus berus venom

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